Closure of Sancta Maria Nursing Facility near Watertown points to concerning national trend

By Diane McLaughlinCambridge@wickedlocal.com

Wednesday

Sep 5, 2018 at 12:35 PMSep 5, 2018 at 12:36 PM

THE ISSUE: After 70 years in Cambridge, Sancta Maria Nursing Facility will close in December, citing financial strains. THE IMPACT: The closure points to challenges faced by nursing homes not just in the Watertown area, but throughout the country due in part to lower reimbursement rates for Medicaid versus Medicare.

The Sancta Maria Nursing Facility celebrated two significant milestones with a cookout in early August. Two weeks later, the facility near Fresh Pond announced plans to close in December.

Citing financial challenges, the nonprofit facility, which cares for both short- and long-term patients, announced on Aug. 17 it will cease operations on Dec. 31. The closing will end Sancta Maria’s 70-year presence in Cambridge and also points to challenges faced by nursing homes throughout the country.

Sancta Maria Nursing Facility administrator Nicholas Gilbert told Wicked Local that, after joining the staff 14 months ago, he thought the facility would overcome financial challenges experienced in recent years. But this past spring, he said, the Board of Directors began to realize the facility would not survive another year.

“People are sad; I personally am sad,” Gilbert said. “It's a disappointment when a facility as good as this closes down.”

According to Medicare’s website nursingcompare.gov, Sancta Maria had an “above average” rating for staffing, while registered nurse staffing was “much above average,” the highest rating. The facility received an overall rating of “average,” with health inspections as its lowest rating.

70 years in Cambridge

Owned and operated by the Catholic religious order the Daughters of Mary of the Immaculate Conception, Sancta Maria first opened in 1948 as a nonprofit hospital at 350 Memorial Drive, site of the former Charlesgate Hospital. A short drive from Fenway Park, many Red Sox players were treated there, earning Sancta Maria the nickname “the Red Sox hospital.”

The hospital moved in 1968 to a larger facility, the current location at 799 Concord Ave. near Fresh Pond. In 1989, the hospital converted to a nursing facility, caring for long-term residents, including dementia patients, and providing short-term rehabilitation services. The facility also offers hospice and palliative care.

Some of the long-term patients have physical ailments but remain cognizant and engaged members of the community, Gilbert said.

This year marked Sancta Maria’s 70th anniversary, as well as the 50th anniversary of the Concord Avenue building. During its time as a hospital, as many as 30 religious women served as nurses, Gilbert said. Today, Sister Mary Theresa Tinana and Sister Mary Lucille Banach have ministerial roles on the facility’s staff.

Gilbert said Sancta Maria’s Board of Directors has begun exploring opportunities to sell the building, including to other health-care providers.

Multiple challenges

One reason for Sancta Maria’s financial difficulty was their patient mix. Gilbert said the facility cared for more long-term patients, those covered by Medicaid or MassHealth, than short-term patients covered by Medicare. In today’s health-care system, facilities receive lower reimbursements for Medicaid compared to Medicare.

Gilbert said Sancta Maria, which has 134 beds, adjusted the patient mix during the past year to an equal number of long- and short-term patients. But the adjustment was not enough to overcome the financial difficulties.

Rising maintenance costs for the 50-year-old building also contributed to the financial burden, as well as a nursing shortage, Gilbert said. Providing a relatively high number of nursing hours for patients each day, the nonprofit facility had difficulty competing for quality nurses, who can find higher salaries at hospitals.

Gilbert, who has worked in health care for about 30 years, described the nursing staff as one of the best he has seen.

“They like working here,” Gilbert said. “They've been working here a long time, and they take really wonderful care, loving care, of our residents.”

Jeannette Dawson, a resident of Sancta Maria who was born and raised in Cambridge, said the facility gave her a renewed appreciation for life.

"When I first came here, I didn't care if I lived or died," said Dawson. "I lost my son. He took coke. And he died at 43 and that's when I started straying away from the church. ...As soon as I came here, I found my way back. ...It was coming here and sister giving me communion every morning."

"These girls took care of me," she added. "They're my kids. I think more than missing here, I'm going to miss them."

Jean Citarella, director of human resources at Sancta Maria, said the public needs to know how dire of a situation this is not just in Cambridge, but around the country. This is a Cambridge facility, employing many Cambridge residents and housing many Cambridge natives, she said.

"It is just something that people need to know about. Unfortunately I don't think people tend to think of what happens to older individuals," she said. "It chokes me up. These people have worked their whole lives. We have veterans here. And they're just not really being paid attention to the way they should be. And that's not Sancta Maria, it's an issue everywhere. They deserve better."

"A place like this shouldn't disappear," Citarella added. "It's what's happening to the residents upstairs, and the angst and the sorrow that they have in terms of displacing these people. And how hard it is to find another bed, especially for people with dementia. It's tragic. It's absolutely tragic. "

Concerns across the country

David Grabowski, a professor of health care policy at Harvard Medical School, said Medicaid and Medicare reimbursements have affected nursing facilities looking to provide long-term care.

“I think the tension playing out at the nursing home in Cambridge is playing out across the country,” Grabowski told Wicked Local.

Nursing homes have also seen a change in long-term patients in recent years. People who in the past might have moved into a facility now have more options for receiving care at home, Grabowski said. Often, people living in nursing homes have acute conditions that require more care from staff.

Staffing is one of the main challenges for these facilities, Grabowski said. Higher staffing levels often lead to better outcomes for patients, but outside Massachusetts, Grabowski said, some facilities choose to understaff, leading to problems with the quality of care.

The simplest solution, Grabowski said, is for states to start increasing Medicaid reimbursements. But with no evidence in either political party of moving toward this approach, Grabowski said another alternative is to look at ways to integrate Medicaid and Medicare payments. Many patients are eligible for both programs, and paying rates through a coordinated system could help address issues with reimbursements.

Many nursing facilities that have closed served urban areas with more Medicaid patients, Grabowski said, adding that they often provided high-quality care.

“Do we need to treat these nursing homes differently?” Grabowski said. “If we don’t address [reimbursements], I think we’re destined to see this story repeat itself.”

Next steps for Sancta Maria

Gilbert has started to hold information sessions for families to discuss the closure and the process of finding new facilities for patients. He is encouraging people to begin the process early to avoid problems in December.

Some patients have resided at Sancta Maria for as long as 15 years. Several have developed friendships after living together for a long time. Gilbert said he would like to find a way to keep these residents together in a different facility.

Gilbert sees the challenges leading Sancta Maria to close as evidence of broader concerns for the future of long-term care.

“What's going to happen if all these facilities close … what's going to happen to all these elderly people in the next generation?” Gilbert said. “That's something as a society we should be thinking of.”